The Effect of Clinical Chorioamnionitis on Cesarean Delivery in the United States.

OBJECTIVE: To examine the association of clinical chorioamnionitis on cesarean delivery in a national sample of hospital discharges. DATA SOURCE: Hospital discharge data from the 1998-2010 Nationwide Inpatient Sample. STUDY DESIGN: We performed a cross-sectional study and general linear modeling was used to determine the association of clinical chorioamnionitis on risk of cesarean delivery. PRINCIPAL FINDINGS: A total of 10,843,682 deliveries and 51,799,431 nationally weighted deliveries were identified. Clinical chorioamnionitis was present in 2.9 percent of cesarean and 1.3 percent of vaginal deliveries (p < .001). In multivariate analysis, clinical chorioamnionitis was associated with a 1.39-fold increased risk of cesarean delivery. Compared with women without clinical chorioamnionitis at an urban/teaching hospital, women with clinical chorioamnionitis at an urban/teaching, urban/nonteaching, and rural hospital were 1.4-1.5 times more likely to have cesarean delivery. Compared with women without clinical chorioamnionitis in the Midwest, the relative risk for cesarean in women with clinical chorioamnionitis was 1.54 for women in the South, 1.47 in the Northeast, 1.39 in the Midwest, and 1.34 in the West. CONCLUSIONS: Women with clinical chorioamnionitis were more likely to have cesarean delivery than those without clinical chorioamnionitis, and the risk of cesarean delivery varied significantly by hospital location, teaching status, and U.S. region.

Discussion: 'Abnormal anal cytology in HIV-infected women' by Baranoski et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Baranoski AS, Tandon R, Weinberg J, et al. Risk factors for abnormal anal cytology over time in HIV-infected women. Am J Obstet Gynecol 2012;207:107.e1-8.

Comparison between spontaneous sedimentation method and Paratest® for the diagnosis of intestinal parasitic infections.

Correct diagnosis of parasitic infections is essential for the treatment of individuals avoiding indiscriminate use of anthelmintics which increases drug resistance. In a comparative study between the spontaneous sedimentation technique and Paratest(®), 140 stool samples were analyzed for the detection of parasites. The prevalence was 12.7% obtained by the spontaneous sedimentation method but only 5.7% using Paratest(®). Paratest(®) has shown a high proportion of false-negative results, lower sensitivity and negative predictive values compared with the spontaneous sedimentation method. Further optimization and studies of the Paratest(®) method are necessary for wider use in clinical diagnosis.

Comparison of costs of surgical site infection and endometritis after cesarean delivery using claims and medical record data.

We used administrative and clinical data from a case-control study to calculate the costs of surgical site infection and endometritis after cesarean delivery. Attributable costs determined by multivariate generalized least-squares regression models with the 2 data sets were similar, suggesting that administrative data can be used to calculate infection costs.

Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery.

BACKGROUND: Accurate data on costs attributable to hospital-acquired infections are needed to determine their economic impact and the cost-benefit of potential preventive strategies. OBJECTIVE: To determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section by means of 2 different methods. DESIGN: Retrospective cohort. SETTING: Barnes-Jewish Hospital, a 1,250-bed academic tertiary care hospital. PATIENTS: There were 1,605 women who underwent low transverse cesarean section from July 1999 through June 2001. METHODS: Attributable costs of SSI and EMM were determined by generalized least squares (GLS) and propensity score matched-pairs by means of administrative claims data to define underlying comorbidities and procedures. For the matched-pairs analyses, uninfected control patients were matched to patients with SSI or with EMM on the basis of their propensity to develop infection, and the median difference in costs was calculated. RESULTS: The attributable total hospital cost of SSI calculated by GLS was $3,529 and by propensity score matched-pairs was $2,852. The attributable total hospital cost of EMM calculated by GLS was $3,956 and by propensity score matched-pairs was $3,842. The majority of excess costs were associated with room and board and pharmacy costs. CONCLUSIONS: The costs of SSI and EMM were lower than SSI costs reported after more extensive operations. The attributable costs of EMM calculated by the 2 methods were very similar, whereas the costs of SSI calculated by propensity score matched-pairs were lower than the costs calculated by GLS. The difference in costs determined by the 2 methods needs to be considered by investigators who are performing cost analyses of hospital-acquired infections.

Risk factors for endometritis after low transverse cesarean delivery.

OBJECTIVE: To determine independent risk factors for endometritis after low transverse cesarean delivery. STUDY DESIGN: We performed a retrospective case-control study during the period from July 1999 through June 2001 in a large tertiary care academic hospital. Endometritis was defined as fever beginning more than 24 hours or continuing for at least 24 hours after delivery plus fundal tenderness in the absence of other causes for fever. Independent risk factors for endometritis were determined by means of multivariable logistic regression. A fractional polynomial method was used to examine risk of endometritis associated with the continuous variable, duration of rupture of membranes. RESULTS: Endometritis was identified in 124 (7.7%) of 1,605 women within 30 days after low transverse cesarean delivery. Independent risk factors for endometritis included age (odds ratio [OR] for each additional year, 0.93 [corrected] [95% confidence interval {CI}, 0.90-0.97]) and anemia or perioperative blood transfusion (OR, 2.18 [CI, 1.30-3.68]). Risk of endometritis was marginally associated with a proxy for low socioeconomic status, lack of private health insurance (OR, 1.72 [CI, 0.99-3.00]); with amniotomy (OR, 1.69 [CI, 0.97-2.95]); and with longer duration of rupture of membranes. CONCLUSION: Risk of endometritis was independently associated with younger age and anemia and was marginally associated with lack of private health insurance and amniotomy. The odds of endometritis increased approximately 1.7-fold within 1 hour after rupture of membranes, but increased duration of rupture was only marginally associated with increased risk. Knowledge of these risk factors can guide selective use of prophylactic antibiotics during labor and heighten awareness of the risk in subgroups at highest risk of infection.

Risk factors for surgical site infection after low transverse cesarean section.

BACKGROUND: Independent risk factors for surgical site infection (SSI) after cesarean section have not been well documented, despite the large number of cesarean sections performed and the relatively common occurrence of SSI. OBJECTIVE: To determine independent risk factors for SSI after low transverse cesarean section. DESIGN: Retrospective case-control study. SETTING: Barnes-Jewish Hospital, a 1,250-bed tertiary care hospital. PATIENTS: A total of 1,605 women who underwent low transverse cesarean section during the period from July 1999 to June 2001. METHODS: Using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI or wound complication and/or data on antibiotic use during the surgical hospitalization or at readmission to the hospital or emergency department, we identified potential cases of SSI in a cohort of patients who underwent a low transverse cesarean section. Cases of SSI were verified by chart review using the definitions from the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System. Control patients without SSI or endomyometritis were randomly selected from the population of patients who underwent cesarean section. Independent risk factors for SSI were determined by logistic regression. RESULTS: SSIs were identified in 81 (5.0%) of 1,605 women who underwent low transverse cesarean section. Independent risk factors for SSI included development of subcutaneous hematoma after the procedure (adjusted odds ratio [aOR], 11.6 [95% confidence interval [CI], 4.1-33.2]), operation performed by the university teaching service (aOR, 2.7 [95% CI, 1.4-5.2]), and a higher body mass index at admission (aOR, 1.1 [95% CI, 1.0-1.1]). Cephalosporin therapy before or after the operation was associated with a significantly lower risk of SSI (aOR, 0.2 [95% CI, 0.1-0.5]). Use of staples for skin closure was associated with a marginally increased risk of SSI. CONCLUSIONS: These independent risk factors should be incorporated into approaches for the prevention and surveillance of SSI after surgery.

Prevalence and predictors of sexually transmitted infection among newly incarcerated females.

OBJECTIVES: To examine demographic and behavioral characteristics in incarcerated women to determine which characteristics are associated with prevalent sexually transmitted infections (STIs). STUDY DESIGN: A cross-sectional analysis of data of 205 women entering jail in Rhode Island was performed as part of a study evaluating a family planning program. Women were recruited near time of commitment, and inclusion was limited to women at risk for an unplanned pregnancy. Incarcerated women were interviewed by a research assistant for demographic information, psychosocial and behavioral characteristics. Self-collected vaginal swabs were tested for STIs, including Neisseria gonorrhoeae and Chlamydia trachomatis by polymerase chain reaction and Trichomonas vaginalis by InPouch culture. Relative risks (RRs) were estimated using Poisson regression. RESULTS: Sixty-eight of 205 patients tested positive for an STI [33%; 95% confidence interval (CI) 27-40%]. Forty-five patients (26%) tested positive for T. vaginalis, 27 (14%) were positive for C. trachomatis, and 21 (11%) were positive for N. gonorrhoeae. On bivariate analysis, 6 or more sexual partners in the last year (RR 1.84; 95% CI 1.01-3.36), exchanging sex for drugs/money (RR 1.65; 95% CI 1.01-2.69), and homelessness (RR 1.82; 95% CI 1.07-3.09) were associated with STI. After adjustment for age, race/ethnicity, education, and other covariates, none of the factors was significantly associated with STI. CONCLUSIONS: The prevalence of STI in this jail population is high. Incarceration represents a unique opportunity to evaluate and treat this underserved population. Predictors of infection are limited and infection is common; therefore, routine screening should be considered in this population.